Amidst Opioid Epidemic, a Call for Collaborative Response
ROCKY HILL - Dr. David Herr remembers one heroin overdose-of many-that he treated around a month ago.

       The patient was revived successfully, and could hardly believe what had happened.

       “He absolutely denied overdosing,” Herr recalls. “He said he spent $10, and that he couldn’t have possibly overdosed on that much money spent.”

       Herr knows all too well that one can, with the introduction of fentanyl laced heroin that delivers exponential potency, at a street price police say is too often lower than that of even marijuana.

       “I can guesstimate that almost all of the overdoses we see are fentanyl related,” says Dr. Steven Wolf, who heads the ER at St. Francis Hospital and Medical Center in Hartford. “I have no doubt.”

       And the hospital, he reports, is seeing a lot more of them relative to just a year or two ago-2017 has already far exceeded 2016’s 106 at the current 196. In 2015, St. Francis treated 68 overdoses, according to Wolf.

       James Cetran, Chief of Police in the Town of Wethersfield-which saw 5 fatal opioid overdoses throughout last year-says the substance has prompted officers to take extra precautions when handling potential drug evidence in the field-they won’t, for instance, break open a suspicious package anymore.

       “Just handling fentanyl can kill you,” Cetran says.

       Herr, a doctor at Johnson Memorial Hospital, says it’s difficult to accurately track the number of overdoses the hospital has handled in recent years due to some cases being diagnosed differently once the patient is admitted, but that if he had to be the gauge, the volume he sees-up from a self-estimated once a month to multiple incidents per shift-is indicative of a larger, state and nationwide trend that has spiraled into epidemic proportions.

       “It’s reached a point where I’d be surprised if I didn’t have at least one in a given shift,” Herr said during a phone conversation. “It’s probably ten times worse than it used to be.”

       Charles Brown at the Central Connecticut Health District-covering Rocky Hill, Newington, and Wethersfield-says that a couple of things are happening: while the addition of fentanyl to the formula is certainly driving the jump in overdoses, the cause of opioid addiction, in recent years, can be traced back to habit-forming prescription pain medication.

       The result is a two-front response effort that has pulled parties from the medical field and law enforcement to the table for what Brown hopes will be a sustained joint campaign to not only enhance treatment mechanisms, but bolster the prevention apparatus in communities across the region.

       The CCHD, which is acting as a facilitator, started looking into the issue as part of an effort to combat Hepatitis C.

       “We started asking what could be the reason, because we’re seeing the effects not just of the drugs, but the diseases that can occur,” Brown said. “We’re challenged because of money, and because we don’t have drug counselors.”

       So right now, the CCHD is focusing on mobilization and education efforts-they’ve held a few forums already within their District towns, where the number of opioid related deaths had already exceeded last year’s by July of this one. Brown reports 18 fatalities as of this past July, compared to 13 for the entirety of 2016.

       Both Johnson and St. Francis have crisis professionals in their emergency rooms to route incoming overdose patients to-they hope-outpatient programs, and the latter hospital is partner to the Manchester Police Department’s Project HOPE, an initiative that seeks to direct victims of opioid addiction, at an officer’s discretion, to the ER for treatment.

       But the challenge always goes back to funding. Herr says it’s always a battle with insurers to cover opioid addiction treatment because withdrawal symptoms are not fatal, and Wolf wonders if next year, he’ll still have the federal grant that has allowed them to put eight crisis coaches in their emergency room.

       “We’ve wanted this for a long time,” Wolf says. “The grant made it possible.”

       As for the impact Project HOPE has had on St. Francis’s inflow of patients, Wolf says it’s tough to tell.

       “We have 93,000 patients,” he said. “So we’re not going to notice that blip.”

       Police departments throughout the state were already working to equip themselves with Narcan-an opioid overdose reversing drug-and legislation passed in 2016 mandates that all emergency medical responders do the same.

       While Connecticut has certainly seen its share of the epidemic, Cetran can only imagine what the fatality numbers would like had it not been for Narcan.

       “It’s a miracle drug,” Cetran says. “Somebody’s on death’s door, and they just come right back. It’s amazing.”

       “You can’t arrest your way out of it,” says Newington Police Chief Stephen Clark. “It’s got such a hold on people, that users are not going to stop just by you arresting them.”

       If there’s one positive aspect of recent developments surrounding the issue, it’s a shift in how public perception of the opioid user is framed, Brown and Wolf said.

       “It’s change in the sense that we no longer see it as a personal feeling-an indication of weakness-but a disease,” Wolf said.

       And that component is critical in what Brown’s primary focus has been, which is to keep the conversation going. Part of his campaign is to “standardize” communication school districts have with students-particularly those who are involved with sports and, therefore, more susceptible to needing prescribed painkillers in the future.

       That’s a fight taken on by both the state legislature-which passed policy in 2016 reducing the permitted window for painkiller prescriptions to 7 days-and the medical community have taken on. The latter of the two has taken its share of criticism as the epidemic has grown, but doctors are constantly walking a line between adequately managing patient pain and ensuring that they don’t stray into the cycle of addiction, Brown and Wolf say.

       A National Institute on Drug Abuse survey-of 50,000 people-cited in a 2017 PBS report found that 60 percent of those who abuse pharmaceutical opioids first obtain the pills not from a prescription, but from a friend.

       Reducing the length of a given prescription, however, can reduce the risk of unused pills landing in the hands of someone susceptible to addiction, the report noted.

       So medical professionals have mobilized toward prevention from their end-adopting new prescription standards that to establish primary physicians as “gatekeepers” that any network of peers would need to refer back to in the event that a user is “doctor hopping” to obtain more opioids than they were approved.

       Guidelines include checking for addiction history, not replacing lost prescriptions of controlled substances, and avoiding long lasting opioids for acute pain management.

       They’re also paying more attention to pain thresholds, Herr says.

       “If you have a broken bone, you’re probably going to get it, but otherwise, we have to measure pain threshold,” Herr says.

       Then, they look to alternatives-medicines like Lyrica and Gabapentin can help some patients suffering from chronic, neuropathic pain better than painkillers, he says.

       “People are starting to ask, ‘how can I manage pain in other ways?’” Brown says.

       While he’s planning to hold more forums this coming January, he admits that he’s getting restless-he’d like to move into action sooner than later, and thinks that the CCHD’s next move is to begin a discussion on how to create “recovery friendly communities”, or, ones that are conducive to keeping former opioid users from going back.

       “This is going to be one of those things that we, as communities, need to look at in the long-term,” Brown said.